Nantavithya et al 2025
International journal of particle therapy · 2025 · Thailand · Proton
This cost-utility study modelled proton beam therapy (PBT) against photon radiotherapy (XRT) for medulloblastoma patients receiving craniospinal irradiation, using Thailand as a representative middle-income setting where PBT is operational. Markov and Monte Carlo (microsimulation) models were built, with early mortality taken from actual medulloblastoma patients over the first 5 years and general population mortality thereafter, and side effects such as hormone deficiencies, hearing loss, IQ decline, brain tumours and thyroid cancer modelled from earlier literature. In the base case, PBT produced a negative ICER (dominant over XRT in cost and QALYs) of -12 211 USD (-415 160 THB) per QALY, and the authors judged PBT cost-effective against the Thai threshold of 4 706 USD (160 000 THB) per QALY. The study concludes that PBT was more cost-effective than XRT, particularly when IQ decline is included, but this conclusion is conditional on that factor.
What it compared
Proton beam therapy versus photon beam radiotherapy (XRT) for modelled medulloblastoma patients receiving craniospinal irradiation in Thailand.
What it found
The base-case ICER was -12 211 USD (-415 160 THB) per QALY, judged against a Thai willingness-to-pay threshold of 4 706 USD (160 000 THB) per QALY; total costs were 69 349 USD for PBT and 80 217 USD for XRT, with utilities of 36.12 and 35.23.
What to keep in mind
The price year is not stated, the discount rate and the particle and comparator costs are not reported in the paper, the cohort is modelled rather than observed (with age, stage and sample size not stated), and the conclusion depends on including opportunity loss from IQ decline, since XRT was more cost-effective when that element was excluded.
The figures it reported
- -12 211 USD (-415 160 THB) per QALYBase case, PBT vs XRT
Figures are shown exactly as the paper gives them, in its own currency and price year. We do not convert between currencies: see the glossary for why.
- Patients modelled or enrolled
- Modelled cohort of medulloblastoma patients receiving craniospinal irradiation; age, stage and sample size not stated. Early mortality based on actual medulloblastoma patients over first 5 years.
- Comparator
- Photon beam therapy (XRT)
- Indication
- Medulloblastoma
- Study design
- Cost-utility analysis using Markov and Monte Carlo (microsimulation) models with probabilistic sensitivity analysis; outcome in QALYs
- Time horizon
- From age 7 (median age of CSI in the real patient cohort) to age 100 or death; Markov cycles of 1 year
- Delivery technique
- not reported by this study
- Perspective
- Patient out-of-pocket perspective and national health care perspective (both assessed)
- Currency
- US$ (THB also reported)
- Price year
- not reported by this study
- Willingness-to-pay threshold
- 4 706 USD (160 000 THB) per QALY (Thai willingness-to-pay threshold)
- Discount rate
- not reported by this study
- Cost of the particle course assumed
- not reported by this study
- Cost of the comparator assumed
- not reported by this study
Whose costs were counted: a payer, a hospital, or society as a whole.
The year the costs are expressed in. Without it, a figure cannot be compared across time.
The condition attached to the finding
PBT was cost-effective in the base case and sensitivity analyses, but XRT was more cost-effective when opportunity loss from IQ decline was excluded from the analysis.
Capital cost assumption
- What it assumed
- For PBT, the cost of each beam delivery was calculated based on infrastructure, treatment machines, licensing, software, maintenance, and manpower (no amortisation period or capital figure stated). PBT delivery cost reported as 43 989 USD (1 495 620 THB) versus 7 459 USD (253 610 THB) for XRT.
- Where that figure came from
- Pricing set according to the guidelines of the Comptroller General's Department of Thailand
Reporting quality
88 out of 100 on the Quality of Health Economic Studies instrument, a 16-item checklist covering the objective, the perspective, the sources of each estimate, the handling of uncertainty, the horizon and discounting, how costs were measured, the model's transparency, the discussion of bias, and whether funding was disclosed. It measures how well the study was reported, not whether its conclusion is correct: a well-reported study can still reach a conclusion a later trial overturns.